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  1. Surveys
  2. 2014
  3. February
  4. W
  5. What do you know about Diabetes
0%
Exit Survey
 
 
What is your gender?
 
Male
 
Female
 
 
 
What is your age?
 
Younger than 18
 
18 - 24
 
25 - 34
 
35 - 44
 
45 - 54
 
55 - 64
 
65 or older
 
Prefer not to answer
 
 
 
What is your date of birth?
 
 
 
What is your marital status?
 
Single (Never married)
 
Married
 
Domestic partnership
 
Widowed
 
Divorced
 
Separated
 
Don’t know
 
 
 
Please select your Hobbies and Interest
 
Auto racing
 
Biking
 
Boating
 
Bowling
 
Camping
 
Crafts
 
Dancing
 
Fine Arts
 
Fishing
 
Gambling
 
Gardening
 
Hiking
 
Hunting
 
Horseback riding
 
Kayaking
 
Martial Arts
 
Music
 
Photography
 
Reading
 
Sports
 
Travel
 
Other

 
 
 
How would you describe yourself?
 
Democratic
 
Republican
 
Independent
 
None of the above
 
 
 
Do you or do you know of someone with Diabetes (Select all that apply)?
 
Myself
 
Family
 
Friend
 
Other